Absorption and metabolism of fructose by rat jejunum

ChREBP deficiency leads to diarrhea-predominant irritable bowel syndrome

OBJECTIVE

Fructose malabsorption is a common digestive disorder in which absorption of fructose in the small intestine is impaired. An abnormality of the main intestinal fructose transporter proteins has been proposed as a cause for fructose malabsorption. However the underlying molecular mechanism for this remains unclear. In this study, we investigated whether carbohydrate response element-binding protein (ChREBP) plays a role in intestinal fructose absorption through the regulation of genes involved in fructose transport and metabolism and ion transport.

METHODS

Wild type (WT) and Chrebp knockout (KO) mice (6 or 8 weeks old) were fed a control diet (55% starch, 15% maltodextrin 10) or high-fructose diet (HFrD, 60% fructose, 10% starch) for 3-12 days. Body weight and food intake were measured, signs of fructose malabsorption were monitored, and the expression of genes involved in fructose transport/metabolism and ion transport was evaluated. Furthermore, transient transfection and chromatin immunoprecipitation were performed to show the direct interaction between ChREBP and carbohydrate response elements in the promoter of Slc2A5, which encodes the fructose transporter GLUT5.

RESULTS

Chrebp KO mice fed the control diet maintained a constant body weight, whereas those fed a HFrD showed significant weight loss within 3-5 days. In addition, Chrebp KO mice fed the HFrD exhibited a markedly distended cecum and proximal colon containing both fluid and gas, suggesting incomplete fructose absorption. Fructose-induced increases of genes involved in fructose transport (GLUT5), fructose metabolism (fructokinase, aldolase B, triokinase, and lactate dehydrogenase), and gluconeogenesis (glucose-6-phosphatase and fructose-1,6-bisphosphatase) were observed in the intestine of WT but not of Chrebp KO mice. Moreover the Na⁺/H⁺ exchanger NHE3, which is involved in Na⁺ and water absorption in the intestine, was significantly decreased in HFrD-fed Chrebp KO mice. Consistent with this finding, the high-fructose diet-fed Chrebp KO mice developed severe diarrhea. Results of chromatin immunoprecipitation assays showed a direct interaction of ChREBP with the Glut5 promoter, but not the Nhe3 promoter, in the small intestine. Ectopic co-expression of ChREBP and its heterodimer partner Max-like protein X activated the Glut5 promoter in Caco-2BBE cells.

CONCLUSIONS

ChREBP plays a key role in the dietary fructose transport as well as conversion into lactate and glucose through direct transcriptional control of genes involved in fructose transport, fructolysis, and gluconeogenesis. Moreover, ablation of Chrebp results in a severe diarrhea in mice fed a high-fructose diet, which is associated with the insufficient induction of GLUT5 in the intestine.

Transporter Gene Expression and Transference of Fructose in Broiler Chick Intestine

Recent studies have suggested that a high-fructose diet leads to the development of metabolic syndrome in mammals. However, relatively little information is available regarding the absorption of fructose in the chicken intestine. We therefore investigated fructose absorption and its transporters in the chicken small intestine. The gene expression of three transporters (glucose transporter protein member 2 and 5 and sodium-dependent glucose transporter protein 1) in the jejunum of fasted chicks were lower than those in chicks fed ad libitum. The everted intestinal sacs (in vitro method for investigating intestinal absorption) showed that the concentration of fructose uptake rapidly increased within 15 min after incubation, and then gradually increased until 60 min. After 15 min of incubation, fructose uptake in the ad libitum chick intestine was approximately 2-fold that in the fasted intestine and was less than half of the glucose uptake in the ad libitum chick intestine. Our results suggest that fructose is absorbed in the small intestine of chicks and that uptake is decreased by fasting treatment with decreases in the mRNA expression of related transporters.

Diabetes regulates fructose absorption through thioredoxin-interacting protein

Metabolic studies suggest that the absorptive capacity of the small intestine for fructose is limited, though the molecular mechanisms controlling this process remain unknown. Here we demonstrate that thioredoxin-interacting protein (Txnip), which regulates glucose homeostasis in mammals, binds to fructose transporters and promotes fructose absorption by the small intestine. Deletion of Txnip in mice reduced fructose transport into the peripheral bloodstream and liver, as well as the severity of adverse metabolic outcomes resulting from long-term fructose consumption. We also demonstrate that fructose consumption induces expression of Txnip in the small intestine. Diabetic mice had increased expression of Txnip in the small intestine as well as enhanced fructose uptake and transport into the hepatic portal circulation. The deletion of Txnip in mice abolished the diabetes-induced increase in fructose absorption. Our results indicate that Txnip is a critical regulator of fructose metabolism and suggest that a diabetic state can promote fructose uptake.

High rates of exogenous carbohydrate oxidation from a mixture of glucose and fructose ingested during prolonged cycling exercise

A recent study from our laboratory has shown that a mixture of glucose and fructose ingested at a rate of 1·8 g/min leads to peak oxidation rates of approximately 1·3 g/min and results in approximately 55 % higher exogenous carbohydrate (CHO) oxidation rates compared with the ingestion of an isocaloric amount of glucose. The aim of the present study was to investigate whether a mixture of glucose and fructose when ingested at a high rate (2·4 g/min) would lead to even higher exogenous CHO oxidation rates (>1·3 g/min).Eight trained male cyclists (VO2max: 68±1 ml/kg per min) cycled on three different occasions for 150 min at 50 % of maximal power output (60±1 % VO2max) and consumed either water (WAT) or a CHO solution providing 1·2 g/min glucose (GLU) or 1.2 g/min glucose+1·2 g/min fructose (GLU+FRUC). Peak exogenous CHO oxidation rates were higher (P<0·01) in the GLU+FRUC trial compared with the GLU trial (1·75 (se 0·11) and 1·06 (se 0·05) g/min, respectively). Furthermore, exogenous CHO oxidation rates during the last 90 min of exercise were approximately 50 % higher (P<0·05) in GLU+FRUC compared with GLU (1·49 (se 0·08) and 0·99 (se 0·06) g/min, respectively). The results demonstrate that when a mixture of glucose and fructose is ingested at high rates (2·4 g/min) during 150 min of cycling exercise, exogenous CHO oxidation rates reach peak values of approximately 1·75 g/min.

GLUT-5 expression in neonatal rats: crypt-villus location and age-dependent regulation

The rat fructose transporter normally appears after completion of weaning but can be precociously induced by early feeding of a high-fructose diet. In this study, the crypt-villus site, the metabolic nature of the signal, and the age dependence of induction were determined. In weaning rats fed high-glucose pellets, GLUT-5 mRNA expression was modest, localized mainly in the upper three-fourths of the villus, and there was little expression in the villus base. When fed high-fructose pellets, GLUT-5 mRNA expression was two to three times greater in all regions except the villus base. Intestinal perfusion in vivo of a nonmetabolizable fructose analog, 3-O-methylfructose, tended to increase fructose uptake rate and moderately increased GLUT-5 mRNA abundance but had no effect on glucose uptake rates and SGLT1 mRNA abundance. Gavage feeding of high-fructose, but not high-glucose, solutions enhanced fructose uptake only in pups > or =14 days, suggesting that GLUT-5 regulation is markedly age dependent. Fructose or its metabolites upregulate GLUT-5 expression in all enterocytes, except those in the crypt and villus base and in pups <14 days old.

Cholecystokinin decreases intestinal hexose absorption by a parallel reduction in SGLT1 abundance in the brush-border membrane

The dual lumenaly and vascularly perfused small intestine was used to determine the mechanism by which cholecystokinin octapeptide (CCK-8) decreases the rate of glucose absorption. With CCK-8 in the vascular perfusate the rate of 3-O-methyl-D-glucose absorption decreased, whereas the rate of D-fructose absorption was unaffected. The substrate pool size within the tissue during steady-state transport, in the presence and absence of CCK-8, was estimated by compartmental analysis of the 3-O-methyl-D-glucose washout into the vascular bed. When CCK-8 was included in the vascular perfusate, the absorptive cell pool size decreased when compared with untreated tissue. Both the steady-state hexose absorption data and the washout studies indicated that the locus of action of CCK-8 was the SGLT1 transporter located in the brush-border membrane. The SGLT1 protein abundance in isolated brush-border membranes, as quantified by Western blotting, showed a decrease that paralleled the decrease in the steady-state transport rate induced by CCK-8. These results indicate that CCK-8 diminishes the rate of intestinal hexose absorption by decreasing SGLT1 protein abundance in the brush-border membrane of the rat jejunum and therefore provides evidence for acute enteric hormonal regulation of the rate of glucose absorption across the small intestine.

The regulation of GLUT5 and GLUT2 activity in the adaptation of intestinal brush-border fructose transport in diabetes

The adaptation of d-fructose transport in rat jejunum to experimental diabetes has been studied. In vivo and in vitro perfusions of intact jejunum with d-fructose revealed the appearance of a phloretin-sensitive transporter in the brush-border membrane of streptozotocin-diabetic rats which was not detectable in normal rats. The nature of the transporters involved was investigated by Western blotting and by d-fructose transport studies using highly purified brush-border and basolateral membrane vesicles. GLUT5, the major transporter in the brush-border membrane of normal rats, was not inhibited by d-glucose or phloretin. In contrast, GLUT2, the major transporter in the basolateral membrane of normal rats, was strongly inhibited by both D-glucose and phloretin. In brush-border membrane vesicles from diabetic rats, GLUT5 levels were significantly enhanced; moreover the presence of GLUT2 was readily detectable and increased markedly as diabetes progressed. The differences in stereospecificity between GLUT2 and GLUT5 were used to show that both transporters contributed to the overall enhancement of d-fructose transport measured in brush-border membrane vesicles and in vitro isolated loops from diabetic rats. However, overall d-fructose uptake in vivo was diminished. The underlying mechanisms and functional consequences are discussed.

Regulation of GLUT5 gene expression in rat intestinal mucosa: regional distribution, circadian rhythm, perinatal development and effect of diabetes

1. GLUT5 gene expression was studied in small intestine under a variety of conditions characterized by altered intestinal absorption of monosaccharides. 2. RNA-blotting studies showed that GLUT5 mRNA was abundantly expressed in rat and rabbit intestine and kidney, but it was not detected in heart or brown adipose tissue. GLUT5 mRNA levels were higher in the upper segments of the small intestine (duodenum and proximal jejunum) than in the lower segments (distal jejunum and ileum). 3. The intestinal expression of GLUT5 mRNA in rat proximal jejunum showed circadian rhythm. A 12-fold increase in GLUT5 mRNA levels was detected at the end of the light cycle and at the beginning of the dark cycle when compared with the early light period. In keeping with this, GLUT5 protein content in brush-border membranes was also increased at the beginning of the dark cycle compared with that in the light period. 4. In streptozotocin-induced diabetes an 80% increase in GLUT5 mRNA levels in mucosa from the proximal jejunum was detected under conditions in which enhanced intestinal absorption of monosaccharides has been reported. 5. The intestinal expression of GLUT5 mRNA showed regulation during perinatal development. Levels of GLUT5 mRNA were low during fetal life, increased progressively during the postnatal period and reached levels comparable with the adult state after weaning. Weaning on to a high-fat diet partially prevented the induction of GLUT5 gene expression. 6. Our results indicate that GLUT5 gene expression is tightly regulated in small intestine. Regulation involves maximal expression in the upper part of the small intestine, circadian rhythm, developmental regulation dependent on the fat and carbohydrate content in the diet at weaning and enhanced expression in streptozotocin-induced diabetes. Furthermore, changes observed in intestinal GLUT5 expression correlate with reported alterations in intestinal absorption of fructose. This suggests a regulatory role for GLUT5 in fructose uptake by absorptive enterocytes.

The effect of beta-adrenoreceptor agonists and antagonists on fructose absorption in man

To explore the effect of beta-adrenoreceptor stimulation and blockade on the extraction of monosaccharide from the upper gut, we first established the malabsorption threshold in 26 normal volunteers using a series of test meals containing varying proportions of fructose and glucose. Incomplete small intestinal extraction and consequent arrival of carbohydrate into the caecum was identified by a rise in exhaled breath hydrogen concentration. The malabsorption threshold varied between individuals from 30 to 80 g fructose (median 40 g) but was reproducible within individuals, with 90% agreement of repeat studies. The malabsorption threshold for an individual was unrelated to body height (tau = 0.007, P > 0.05) or weight (tau = 0.003, P > 0.05) but correlated closely with time to onset of the breath hydrogen rise of a standard meal (tau = 0.70, P < 0.001). Administration of the beta-adrenoreceptor antagonist propranolol (160 mg) reduced the quantity of fructose required to exceed the malabsorption threshold from 45, 30-60 (median and range) to 40, 30-50 g (P = 0.03); administration of the beta-adrenoreceptor agonist isoprenaline (0.015 micrograms.kg/min) increased the quantity of fructose required to exceed the malabsorption threshold by 10 g (55 (50-90) g; P < 0.02). The effect of both drugs correlated closely with their transit effect (tau = 0.79, P < 0.01). A beta-adrenoreceptor mediated pathway thus appears to be capable of influencing the extraction of monosaccharide from the small intestine in normal subjects both under resting and stimulated conditions, probably acting via an effect on upper gastrointestinal motility.

Fructose and related food carbohydrates. Sources, intake, absorption, and clinical implications

It is possible to point out subjects consuming considerable quantities of fructose and sorbitol, and the intake seems to be increasing both from added and natural sources. Studies of the absorption of fructose in animals are inconsistent, and the mechanisms of fructose uptake seem to vary in accordance with the species. In most species fructose absorption takes place by a specific carrier (facilitated transport), but it may be active in the rat. In vitro studies of human intestine are very scarce; there is no evidence of active intestinal fructose transport in the human intestine. By means of hydrogen breath tests, a very low absorption capacity for fructose given as the free monosaccharide has been found in humans. Fructose given as sucrose or in equimolar combinations with glucose is well absorbed, and only fructose in excess of glucose is malabsorbed. On this basis it is hypothesized that two different uptake mechanisms for fructose are present in the human intestine. One of these may be a disaccharidase-related uptake system. Sorbitol ingestion may aggravate malabsorption of fructose given as the monosaccharide; it is not known whether a specific mechanism is involved. In children and adults with functional bowel distress the absorption capacities for fructose may not differ from those of healthy individuals, but malabsorption of fructose and/or sorbitol may be the cause of or aggravate abdominal symptoms. Fructose polymers (fructans) are also subject to increasing nutritional interest. Fructans are not absorbed in the small intestine but are strongly fermented in the large bowel. Fructans may be of potential benefit for large-bowel function and blood glucose regulation.

Effects of olsalazine in the jejunum of the rat

Olsalazine (ADS) is the azo-linked dimer of 5-aminosalicylic acid (5-ASA). It is of value for the management of patients with ulcerative colitis but may be associated with increasing diarrhoea in a few. This study examines the effect of 5-ASA and ADS on small intestinal transport systems of the rat. Krebs-Ringer-bicarbonate solution was circulated through the lumen of a jejunal segment and the appearance of fluid, glucose and lactate on the serosal surface was shown to be linear over a two hour period. Addition of 5-ASA (10 mmol/l) or ADS (5 mmol/l and 10 mmol/l) caused a significant inhibition both of fluid transport (p less than 0.001), and of the appearance of glucose (p less than 0.001) and lactate (p less than 0.001 for 5 mmol/l and 10 mmol/l ADS, p less than 0.01 for 10 mmol/l 5-ASA). The uptake of glucose by rings of rat jejunum was shown to be markedly reduced by ADS. Experiments substituting glucose with either sucrose of 2-aminoisobutyric acid showed that ADS (5 mmol/l, 10 mmol/l) also inhibited the serosal appearance of fructose and the amino acid. These results show that 5-ASA and ADS, at concentrations which could be expected in the jejunum of patients receiving therapeutic doses, are able to inhibit small intestinal transport systems. The resulting increase in load on the diseased colon could be important for the pathogenesis of diarrhoea.

Absorption capacity of fructose in healthy adults. Comparison with sucrose and its constituent monosaccharides

The capacity to absorb fructose in 10 healthy adults was investigated by means of hydrogen breath analysis. Fructose absorption was quantified with lactulose standards. Significant hydrogen production (greater than or equal to 20 ppm rise of breath hydrogen) was found after challenge with 10% solutions of 50, 37.5, 25, 20, and 15 g fructose in eight, seven, five, four and one subjects, respectively. One subject showed malabsorption after a 10 g dose and possibly also 5 g fructose. In contrast, no malabsorption could be detected in any of the 10 subjects after ingestion of 100 g, 75 g, or 50 g sucrose or a mixture of 50 g glucose and 50 g fructose. After ingestion of mixtures of 50 g fructose +25 g glucose and 50 g fructose +12.5 g glucose malabsorption was present in three and seven subjects, respectively. Symptoms during all challenges were mild, or absent. It is concluded that in the healthy state the absorption capacity of fructose given alone ranges from less than 5 g to more than 50 g. The absorption capacity of fructose given as sucrose is much higher. Glucose stimulates fructose uptake in a dose dependent fashion. The possible existence of more than one intestinal transport system for fructose is considered. The elucidation of the clinical relevance of the findings is important.